Form W-8ce - Notice Of Expatriation And Waiver Of Treaty Benefits - 2009
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1
2W-8CE
Notice of Expatriation and Waiver of Treaty Benefits
Form
OMB No. 1545-2138
(November 2009)
Section references are to the Internal Revenue Code.
Department of the Treasury
Give this form to the payer. Do not send to the IRS.
Internal Revenue Service
Name of owner
U.S. taxpayer identification number
Expatriation date
Permanent address
City, province or state, postal code, and country
Current mailing address, if different from permanent address. Include apt. or suite no., or P.O. box if mail is not delivered to street address.
City, town or post office, state, and ZIP code. If you have a foreign address, enter city, province or state, postal code, and country.
Under penalties of perjury, I certify that I am a covered expatriate (as defined in the instructions below). Furthermore, I authorize
this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial
owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner.
Account Number
Name of payer
(or other identifying information)
For the payer above, check the box below if you had any of the following items on the day
before your expatriation date (see instructions).
Eligible Deferred Compensation Item. Checking this box notifies the payer that you are
1.
irrevocably waiving any right to claim any reduction in withholding for such eligible deferred
compensation item under any treaty with the United States (see instructions)
2.
Ineligible Deferred Compensation Item
Specified Tax Deferred Account
3.
Nongrantor Trust. Checking this box notifies the payer that you will be treated as having waived any
4.
right to claim any reduction in withholding on any distribution from this trust under any treaty with the
United States (see instructions)
Checking this box notifies the payer that you are electing to be treated as having received the value of your interest in the trust on
the day before your expatriation date and that you will be subject to withholding under section 877A until the payer receives (a) a
copy of the letter ruling issued by the IRS stating the value of your interest in the trust and (b) your certification that you have paid
any tax due on the receipt of the value of your interest in the trust (see instructions).
Signature
Date
Long-Term Resident. For expatriation
General Instructions
obligations for the preceding 5 years or
purposes, a long-term resident is any
have not submitted evidence of such
individual who was a lawful permanent
compliance.
Purpose
resident of the United States in at least 8
Exceptions. Statements (1) and (2) above
out of the last 15 tax years ending with the
Use Form W-8CE to notify the payer that
do not apply if:
tax year of expatriation.
you are a covered expatriate individual
● You became a U.S. citizen and a citizen
subject to special tax rules.
Expatriation date. Your expatriation date is
of another country at birth and, as of your
the date you relinquished U.S. citizenship or
Covered Expatriate
expatriation date, continue to be a citizen
the date on which you ceased to be a lawful
of, and taxed as a resident of, such other
You are a covered expatriate if you are an
permanent U.S. resident.
country, and you were a U.S. resident for
expatriate to whom any of the following
not more than 10 tax years during the
Who Must File
applied on your expatriation date.
15-year period ending with the tax year in
1) Your average annual net income tax for
Covered expatriates are required to give
which you expatriated, or
the 5-year period ending the year before
Form W-8CE to the payer if they had any of
● You relinquished U.S. citizenship before
your expatriation date is more than
the items identified in Boxes 1 through 4 on
the age of 18
1
⁄
and were a U.S. resident
$145,000 (for 2009 and 2010). This amount
2
the day before their expatriation date. In
for not more than 10 tax years before your
is indexed for inflation. For years after 2010,
addition, all expatriates must file Form 8854
expatriation date.
see the Instructions for Form 8854 for the
with the Internal Revenue Service.
adjusted amount.
Expatriate. An expatriate is a U.S. citizen
Deferred compensation items. Deferred
who relinquished citizenship or a long-term
2) Your net worth is $2 million or more.
compensation items include any interest in
resident who ceased to be a lawful
a plan or arrangement described in section
3) You have not certified under penalties
permanent resident.
219(g)(5), any interest in a foreign pension
of perjury that you met all federal tax
plan or similar retirement arrangement
W-8CE
For Paperwork Reduction Act Notice, see page 2.
Cat. No. 51945M
Form
(11-2009)
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